MANPOWER AND PERSONNEL

During Operation Desert Shield/Storm our sailors and marines once again proved not just their skills, but their bravery and dedication. In order to retain such people we must continue to meet their expectations for top-notch facilities, equipment and training and to provide the quality of life they and their families deserve. Taking care of them ensures we protect the single most important strategic asset of our Armed Forces our people!

We are on course to reach our target of 12,510 officers by the end of this fiscal year. Charts are provided with the discussion of each corps community which show end of year end strengths for the past several years and fiscal years 1992-1993 projections.

Medical Officer Retention Bonus

MEDICAL CORPS

The Medical Officer Retention Bonus (MORB) authority expired on September 30, 1990 after 2 years in existence. Analyzing the Fiscal Year 1989 MORB, the Center for Naval Analysis found indications that the MORB had positive effects on the short-term retention in some specialties. Preliminary analysis for the Fiscal Year 1990 MORB indicates similar findings. Thorough analysis will take several years as the MORB is a 2 through 4 year retention program. In January 1991, the MORB was replaced by the multiyear and incentive special pays.

Multiyear Special Pay

The fiscal year 1991 National Defense Authorization Act authorized a new pay structure which included a Multiyear Special Pay (MSP). This multiyear special pay is intended to improve retention, and when combined with the new Incentive Special Pay (ISP) reduces the pay gap between military specialists and their civilian counterparts. Our analysis of Medical Officer retention trends are hampered at this time by the fiscal year 1991 stop-loss policy, our inexperience with the program, and the fact that many of the officers eligible for the MSP had previously accepted the MORB thereby skewing the findings related to the MSP.

Physician Recruiting and Retention

The Armed Forces Health Professions Scholarship Program (AFHPSP) continues to be our primary Medical Corps recruitment source, accounting for well over 70 percent of our accessions; about 272 per year. Over 95 percent of General Medical Officers, Flight Surgeons, and Undersea Medical Officers serving with operational units come to us from this program. This year we are authorized 1,375 positions.

Improving retention continues to be a major goal. The Medical Corps Quality Management Board (MC/QMB) is examining ways to increase retention by improving our ability to meet Medical Corps Officers' professional and personal needs at all stages of their careers.

DENTAL CORPS

I am increasingly concerned about our ability to recruit and retain general and specialty trained dentists. The number of dental student graduates has decreased 37 percent since its peak in 1978. Dental school closures, exorbitant educational indebtedness of recent graduates, increasing pay disparity (particularly among specialty trained dentists) and decreasing interest in military service serve as challenges to Dental Corps recruitment and retention.

Increased recruiting efforts through direct accession programs (dentists recruited from the civilian marketplace) and our 1925-I dental student early commissioning program have produced somewhat disappointing results. This program, once the backbone of our recruiting efforts, has a quota of 57 dental students; to date only 8 students have signed on. Although we have reduced our direct accession quota from 58 dentists to 46 in accordance with force reduction projections, we have to date reIcruited only 6 dentists. The Navy Dental Corps is projecting a shortfall of 50 lieutenants through the end of the calendar year.

We have already taken several actions in response to these trends. First, we restored the dental student AFHPSP. This highly pursued program has been successful in improving the quality of applicants. Twenty scholarships were awarded in fiscal year 1991, 12 are available in fiscal year 1992.

Over the past 3 years, it has grown exceedingly difficult to retain oral and maxillofacial surgeons. They are resigning and retiring at alarming rates. To assist recruitment of oral and maxillofacial surgeons, we are providing monetary incentives through the Financial Assistance Program (FAP) to residents in their second or subsequent years of training. The FAP, introduced in fiscal year 1991, has had limited success; only two of five available scholarships have been awarded.

The Medical Service Corps continues to be a healthy community in the Navy Medical Department with a broad diversity of administrative, clinical, and research backgrounds. Retention rates for the last 5 years have consistently exceeded 90 per

cent.

Notwithstanding the overall balance of the Medical Service Corps, certain specialty shortages continue to exist. These specialties remain the focus of aggressive accession and retention initiatives.

In an effort to increase the pool of eligible applicants, we are granting entry age waivers authority for clinical psychology, pharmacy, optometry, occupational therapy, and physician assistants. We offer work experience credit to pharmacists and physician assistants. Our clinical psychology internship program was doubled to enhance the primary accession base. The Army post-doctoral psychotropic medication program is in full operation, supported by two Navy clinical psychologists. Authority to use the AFHPSP for optometry was re-instituted in 1991. Implementation and funding for this initiative are in the budget you are reviewing now.

The shortage of qualified physician assistants and a growing disparity between civilian and military starting salaries have hampered our recruiting efforts. This year we created the Health Services Collegiate Program (HSCP) for physician assistant and pharmacy students. Similar to the highly successful Nurse Corps Bachelor Degree Completion Program (BDCP), this program is designed to provide financial assistance to students enrolled in accredited physician assistant or pharmacy baccalaureate degree programs. Graduates are commissioned in the Medical Service Corps. The Navy expects to receive 54 new physician assistants and 26 pharmacists over the next 5 years through this program. While it is too early to evaluate its success, we are optimistic this initiative will attract quality physician assistants and pharmacists.

Our in-house physician assistant training program remains our primary means of meeting requirements. In addition to the 25 students enrolled each year in our training program, 15 Navy students enrolled in the Army physician assistant train

ing program at Fort Sam Houston, Texas, in September 1991. I anticipate a healthy and stable physician assistant community by 1997.

I am confident that our recruiting efforts in conjunction with expanded professional opportunities will help to sustain a healthy Medical Service Corps.

NURSING PERSONNEL

Improvements continue in Nurse Corps recruitment efforts through the scholarship programs established in 1991. However, the long term impact of the national nursing shortage will challenge direct appointment recruitment and other retention programs for the foreseeable future. A 1991 survey conducted by "Modern Healthcare" showed raises for staff nurses range from 7.1 percent to 10.6 percent. Salary increases impact on both military and civil service nurse recruitment and retention. We are working with the Assistant Secretary of Defense (Health Affairs) to request extension beyond September 1992 of three important nurse retention and recruitment initiatives including the incentive special pay for nurse anesthetists, the $5,000 accession bonus, and the nurse candidate program to keep us competitive in the nurse personnel market place.

The removal of congressional limitation for nurse candidate program (NCP) in 1990 to allow recruiting on other than Navy ROTC campuses has aided recruitment into this program. We filled the 25 funded fiscal year 1993 vacancies since October 1991 and have additional applicants. We anticipate more interest in this program since it provides a viable alternative to the health services collegiate program (HSCP) formerly the baccalaureate degree completion scholarship program (BDCP). The HSCP approved over 150 applicants in fiscal year 1991 and we expect over 300 students selected during fiscal year 1989 and fiscal year 1990 to graduate and be commissioned into the Nurse Corps this year. We continue to be optimistic about participation in the Nurse Naval Reserve Officer Training Corps (NROTC) Scholarship Program. Expansion to a full 4 year program in June 1990, increased our ability to attract qualified students into a nursing career. Eligibility criteria for the medical enlisted commissioning program (MECP) were expanded to accept appli

53-293 - 92 - 19

cations from all enlisted ratings in 1990. This year we again had many more highly qualified applicants than billets.

Retention remains our number one priority. The list of over 50 retention initiatives sent by the Director, Navy Nurse Corps to hospital commanding officers and directors of nursing services in 1990 are in place throughout our health care system. These initiatives focus on professional practice, communication, work environment, personal satisfaction, career development, continuing education, individual recognition, compensation, promotion, flexible scheduling, subspecialty groups concerns, and many other areas.

We continue to work with the Chief of Naval Personnel to alleviate the promotion disparity for nurses in legally controlled grades (O-4 through O-6). The Nurse Corps had constrained promotion to Commander and Lieutenant Commander for several years resulting in decreased career mobility and job satisfaction. Recent improvement in the promotion process for Nurse Corps officers brings opportunity more "in line" with DOPMA guidance for the control grades (O-4 through O-6); however, flowpoint to commander remains outside DOPMA guidance. These improvements have been possible only through compensation of control grade numbers from the unrestricted line community. The discretionary use by each service secretary of the authority to exceed DOPMA restrictions on nurses, at the expense of other competitive categories, while remaining within grade table limits, should allow time to develop additional strategies to remedy these inequities.

Gaps between military and civilian salary continue to impact retention of nurse specialists in particular. Early evidence suggests that the Incentive Special Pay (ISP) of up to $6000 per year for certified registered nurse anesthetists (CRNA) is working. We continue to recruit specialists through our Full Time Outservice Scholarship Training Program (FTOST) and have several nurses enrolled in anesthesia, family nurse practitioner, critical care, and midwifery master's degree programs. Increasing midwife positions from 4 to 22 over the next 4 years will enable us to further improve access to care and help contain costs. The opportunity for full-time duty under instruction to prepare for this expanded clinical role also is a retention incentive for nurses interested in a career in the specialty.

The use of associate degree nurses in the Navy includes a program in place since 1989 to access associate degree nurses, with a related bachelors degree, as commissioned officers in the active or Reserve Nurse Corps. Additionally, the Secretary of the Navy established the Technical Nurse Warrant Officer (TNWO) community in February 1990 to afford an opportunity for associate degree educated nurses to enter the Navy. There are over 80 nurse warrant officers currently assigned to four of our large hospitals-Bethesda, Oakland, Portsmouth, and San Diego. They provide direct patient care on a variety of medical and surgical units and thereby increase our overall nursing capability. We are exploring the possibility of assigning nurse warrant officers to selected medium-sized facilities as their second tour and are developing a process to select them for duty under instruction to complete a baccalaureate degree in nursing and qualify for a commission in the Nurse Corps.

We must maintain a balance in recruiting and retention initiatives to provide adequate professional practice compensation for our new as well as our proven and experienced officers. These and other retention and recruitment incentives will continue to be evaluated and monitored as methods to attract and retain the nursing professionals we need to meet our commitments.